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Background Magnetic resonance intracranial black blood vessel imaging (MR-IBBVI) is a new noninvasive method for evaluating intracranial vessel wall pathology. No previous studies have investigated the efficacy of MR-IBBVI to determine aneurysm size. We aimed to identify the precise diagnosis of MR-IBBVI for the detection and measurement of intracranial aneurysm compared with gold standard cerebral digital subtraction angiography (cDSA). Materials and Methods The retrospective study collected patients of precoiled or postcoiled intracranial aneurysm who were treated at our institute from January 2012 to June 2019 and who had MR-IBBVI, cDSA imaging, and/or three-dimensional time-of-flight sequence of magnetic resonance angiography. The sensitivity and specificity of aneurysm detection by MR-IBBVI and the accuracy of MR-IBBVI for measuring the aneurysm and vessel size were calculated. Results One hundred and twenty patients (61% female) with 132 aneurysms were included into this study. The mean aneurysm size was 5.3 mm (range: 2.2-22.6). Sensitivity and specificity of MR-IBBVI to detect a small aneurysm were 98.74 and 91.21%, respectively. No statistically significant results were observed between MR-IBBVI and DSA for aneurysm detection or any of the evaluated measurement parameters. Conclusion MR-IBBVI is an accurate and highly sensitive method to detect and evaluate the size of an intracranial aneurysm both before and after coiling.
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BACKGROUND AND PURPOSE: The aim of this study was to investigate the efficacy of thrombus density on noninvasive computed tomography (CT) neuroimaging for predicting thrombus pathology and patient outcome after mechanical thrombectomy in acute ischemic stroke. MATERIALS AND METHODS: This retrospective chart and imaging review included patients that were treated by mechanical thrombectomy at Siriraj Hospital according to the American Heart Association/American Stroke Association guidelines for the early management of patients with acute ischemic stroke from March 2010 to February 2015 study period. Preintervention noncontrast CT (NCCT), CT angiography (CTA), and/or contrast-enhanced CT (CECT) images were interpreted using CT densitometry. Pathology results were classified as white, red, or mixed thrombi. The result of treatment was evaluated by the modified Rankin Scale at 90 days after treatment. RESULTS: From 97 included patients - 97 NCCT images, 48 CTA images, 48 CECT images, and 54 pathologic results of cerebral thrombi were included in the final analysis. Mean clot Hounsfield unit values on NCCT, CTA, and CECT were significantly different between red and white thrombus (P = 0.001 on NCCT, P = 0.03 on CTA, and P = 0.001 on CECT), and between red and mixed thrombus (P = 0.043 on NCCT and P = 0.002 on CTA). However, no significant difference was observed between white thrombus and mixed thrombus (P = 0.09 on NCCT, P = 1.00 on CTA, and P = 0.054 on CECT). There was no significant correlation between type of cerebral thrombus or clot density and the result of treatment. CONCLUSION: Thrombus density on CT was found to be a significant predictor of thrombus pathology; however, no significant association was observed between thrombus type or clot density and patient outcome after mechanical thrombectomy.
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This retrospective study evaluated the relationship between intervertebral cement leakage and new adjacent vertebral fracture and describes the different characteristics of cement leakage. Increased risk of new adjacent vertebral fracture (NF) has been reported to be a complication of cement leakage in vertebroplasty. In our observation, an incidental intervertebral cement leakage may occur during vertebroplasty but is commonly asymptomatic. The study focused on osteoporotic collapse patients who had percutaneous vertebroplasty (PV) between 2005 and 2007. We divided patients into leakage and non-leakage groups and compared the incidence of NF. Leakage characteristics were divided into three types: Type I intervertebral-extradiscal leakage, Type II intradiscal leakage and Type III combined leakage. Visual analog scale for pain and the Karnofsky Performance Status at 24 h, three months, six months and one year were compared between groups and types of leakages. Among 148 PVs (102 patients) there were 30 leakages (20.27%) and 21(14.19%) NFs. The incidence of NF did not significantly differ between leakage and non-leakage groups (P<0.05). Type II was the most common type of leakage (15/30). Reduction of average pain and improvement of Karnofsky Performance Status score did not differ between groups (P< 0.05). Type II had decreased pain score < type I and III at 24 h (P < 0.01), three months and six months (P < 0.1) but not at one year (P<0.10). Type II also had decreased pain score < non-leakage group only at 24 h (P<0.05). Intervertebral cement leakage is not an increased risk for NF, influenced outcomes of pain relief or improvement of physical function. Intradiscal leakage (Type II) is the most common characteristic of cement leakage and probably related to delayed pain relief.